Real Stories Debbie Garratt RN M.Ed, B.Ed, B.N, Cert. Couns Executive Director Real Choices Australia

Setting the Scene

Pregnancy termination is a highly emotive and politically sensitive issue. People tend to have strong opinions one way or another. The topic has now become so sensitive, so politicised that we are no longer sensitive to the person who is at the heart of the issue: the woman.

The debate always centres around the word ‘Choice’ Yet ‘choice’ often means choosing abortion Those who most loudly advocate ‘choice’, do little, if anything to support any option but abortion. Discussion about alternatives to abortion are usually marginalised as ‘anti-choice’, or narrow minded religious conservatism

What is Choice? For real choice to exist, there needs to be at least 2 alternatives from which to choose. There is something inherently coercive about the messages a woman hears about ‘her choice’, and the lack of supports she receives in society if she continues a pregnancy.

3 Women’s Stories These case studies raise important questions about informed consent, accurate information giving, and whether we are applying even the most basic of best practise medical standards to pregnancy termination. Abortion has become such a political hot potato that we are ignoring the real needs of women and the ethical and professional standard of care women are entitled to…. Even in the confines of the doctor patient relationship, and especially when that doctor derives their major income from abortion.

Some believed they were genuinely making the right decision at the time, and later came to learn more information about what that meant or what other options they might have had. Some felt extremely pressured, by family, partners, circumstances and the health professions. Others simply felt pushed along by time and circumstances and felt they didn’t make a decision at all.

Anna Married with 3 children, unexpectedly pregnant with a ‘wanted’ baby. Previous history (based on self report of symptoms) of antenatal psychosis with last pregnancy.

Anna’s report of the ‘consultation’ with the abortion provider consisted of the following. ‘the doctor said.. ‘I expect you’re making the right decision’… I just glared at him and said ‘how can anything be ‘right’ about what I’m doing?’ She had no further conversation with the doctor until after her procedure when he explained the need to take antibiotics.

‘yesterday all the reasons to do it, seemed so important, but at least I would have only had to live with them for a few more months. today I have to live with how I’m feeling for the rest of my life’ 2 years later, Anna continues to report sexual dysfunction and ‘flashbacks’ to the abortion procedure

A different perspective

24 years old, practising Catholic, recently separated from her husband of 2 years, had been trying to conceive for 6 months and discovered she was pregnant one week after the separation. Experienced substantial pressure from her husband, who had entered an new relationship, to terminate the pregnancy. Also experienced pressure from her family, who believed it ‘best’ for Rebecca to terminate given her husband’s new relationship and lack of support Rebecca

‘the doctor told me that my attempted overdose had probably damaged my baby so it was better to have an abortion.’

Rebecca called her sister to collect her and asked her sister to make an appointment for the termination. Rebecca arrived at the abortion clinic with her sister and was so distraught that she was unable to fill out the paperwork. Her sister completed it for her while Rebecca cried, only signing it at the end. Her ‘consultation’ was less than 10 minutes and consisted mostly of Rebecca crying and saying ‘I don’t know what else to do’. She was ‘reassured’ that this was the right thing.

Rebecca says… I never stopped crying.. Not once …I climbed on that bed crying, I woke up crying, I left there crying…’ I can’t sleep ever… I keep hearing a baby cry… I don’t know how this could have happened to me… I really wanted that baby…’

Informed Consent?

Simone 22 weeks pregnant with a long awaited second child Routine ultrasound shows the unborn baby has a ‘bladder problem’ A visit to a paediatric specialist gives her a ‘worst case’ scenario information Simone is told repeatedly how negatively it will impact on her current child if she has a baby with a ‘problem’

The gynaecologist tells her it would be selfish of her to put a baby through ‘this’. Simone is referred to a second gynaecologist who will do a termination. She is now 23 weeks and 3 days pregnant

She asks this gynaecologist for more information about what is wrong with her baby. The gynaecologist doesn’t know, but assures her that she is probably doing the ‘right’ thing.

On the day of this consultation, a Wednesday, the gynaecologist tells her that she will have to her termination by Friday as after that she will be over 24 weeks and they will have to involve an ethics committee, and this will make things ‘very difficult’ for her. On Friday, Simone is admitted to the maternity ward for a labour induction. She asks the midwife… ‘do you think I should do this’ The midwife replies.. ‘it is not my place to judge you, I’m sure you’ve made the right choice’

‘When I asked my GP why nobody suggested I could have the baby, she said it was because nobody else would have… everyone would have had an abortion…’ ‘I told her they wouldn’t if they knew how it felt.’

Everywhere I went, I kept expecting someone to ‘talk to me’ about what I wanted to do… at the doctors.. When I went to the abortion doctor… when I arrived at the hospital… but nobody did… they all just said… ‘this is the best thing… it’s your decision… some even told me it would selfish to do anything else. But I didn’t really know what ‘anything else’ would be. Simone says….

Never once did anyone say to me ‘you have a choice… and here is the other choice… here is what can be done to support you to have your baby…’ ‘They all said I was making the right choice, but it never felt like I was making one at all’

Simone spent the 7 weeks following her termination, unable to even look at her 2 year old child… ‘I can’t help thinking that if I didn’t have her, I would have been able to keep my baby… then everyone wouldn’t have said I was selfish…’

Lets look at these cases in the context of what it means to provide consultation to a woman in a pregnancy counselling setting.

More than 90% of pregnancy terminations are undertaken for psychosocial reasons. This means that for these women to truly experience a ‘choice’ they need to be offered information, strategies, and resources which may meet their economic, emotional, material or other needs. Most of them don’t receive this support or information at any point in the process.

‘non-directive’ counselling Does not mean…. That women are not to be offered or given information they may not ask for… you cannot know something you don’t know…. That women are not entitled to be offered full and frank information about all the possible outcomes of all of their options, including the possibility of a negative experience from abortion.

As health professionals we do need to listen, understand and respect the woman’s experience and her ability to make her own decision. This does not mean leaving out vital information because of our personal beliefs, or the political issues surrounding choice. We also have a responsibility to ensure that women have access to all the information and resources they require to be fully informed.